Question
Are there any breeds or types of dogs that won t trigger allergies in dog-allergic people?
Answer
The reason some people are allergic to dogs is because their immune system reacts to specific proteins (allergens) in the dog’s dander, saliva and fur. Not all dog-allergic people react to the same dog allergens, and not all dogs produce or shed the same amount of all dog allergens. So it is theoretically possible that some dogs could be better tolerated than others. In the past, some have thought that breeds known to shed less fur ought to shed fewer allergens. These so-called “hypoallergenic” dog breeds include as Samoyeds, Portuguese water dogs, Afghan hound poodles, Airedale terriers and Malteses. However, homes containing these theoretically less allergenic breeds may have the same dog allergen contain as houses where fuzzier breeds curl up at the foot of the bed, according to a recent study of residences around Detroit, Michigan. The researchers from the Henry Ford Health System in Detroit in conjunction with the Georgia Health Sciences University examined the content of homes for the common dog allergen Canis familiaris 1 (Can f 1) and found detectable levels in 94% of the 173 homes they tested. In fact, the levels of common dog allergen, Can f 1, were not statistically different between houses inhabited by “hypoallergenic dogs” and those harboring other breeds!1Thus, while it appears there are differences in the amount of allergen shed by individual dogs, there are no clear and consistent differences between breeds, even those that shed less fur or are thought to be less allergenic. So there is no guarantee that picking a dog of a particular breed is a good way to reduce the amount of allergen in your home or to avoid symptoms. Perhaps someday we will be able to routinely determine which allergens an individual person reacts to, and measure the levels of those allergens shed by individual dogs. Perhaps choosing a pet based on this strategy would lead to fewer symptoms. For now, that strategy is unproven and those tests are not readily available. And there is no guarantee that, over time, you won’t develop an allergy to one of the other dog allergens, or that the dog won’t produce higher levels of those allergens later in its life. In the meanwhile, your allergist is able to evaluate your dog-related symptoms and prescribe the best medicines to prevent or treat those symptoms. In addition, allergen immunotherapy (allergy shots) can expose you to dog allergens in such a way that you actually become less allergic to dogs over time. Unfortunately, for some people, the best medical advice is to avoid exposure to dogs that cause or exacerbate your symptoms. Don’t be looking for love in all the wrong places!1 Nicholas et al, “Dog allergen levels in homes with hypoallergenic compared with nonhypoallergenic dogs”, American Journal of Rhinology & Allergy. 2011;25(4):252-6.
Question
We are looking into getting a family puppy, but we have a child who has been allergic to dogs in the past. Is it true that hypoallergenic dogs will not cause discomfort for an allergic child? We are currently looking into getting a Weimaraner puppy. Is there medication the child could take? Would slow exposure to the puppy build up a resistance?
Answer
Many patients hope to purchase a “hypoallergenic” dog or cat, but unfortunately these pets do not exist.
Avoidance is the most effective way to manage dog allergy. Before bringing a pet into your home, I recommend you discuss your child’s history with his or her allergist.
Although data suggest that children who are exposed to pets during infancy may be less likely to become allergic to dogs and cats in later life, in a child with history of an established dog allergy, slow exposure to the puppy would not be expected to desensitize your child.
Question
I had an egg allergy when I was a kid, around 5-6 years old. Now I’m 33 and no longer seem to have any reaction to eggs. I would like to get a flu shot, but I’ve been told I need to be sure I don’t have an egg allergy. I eat eggs every morning and don’t notice any reaction, so I don’t think I’m allergic anymore. Can I just get the flu shot? What do you suggest?
Answer
If you are tolerating eggs daily without symptoms, you are no longer allergic to eggs. If you do not have any skin, stomach, swallowing, throat, or breathing symptoms related to eating eggs; then you do not have to worry about egg allergy. You should get the influenza vaccine annually, and you do not need any special precautions or monitoring.
Question
I have moved into a house where two cats lived. They are gone, but I am sick all the time with a cough and wheezing and headache, which I never had before. I am 80 years old with pulmonary hypertension, and I moved from an elevation of 6,000 feet to sea level. How long does the hair and dander remain after cats are gone?
Answer
Your first step should be to consult with an allergist to determine if you are asthmatic. While asthma can develop at any age, if this is the first time you have had wheezing and coughing, your symptoms may not be related asthma. Pulmonary hypertension can also cause respiratory symptoms, especially shortness of breath.
Your allergist can perform a simple in-office allergy test to determine if you are allergic to cats, dust mites, or other common allergens for your geographical region.
In a home that previously had cats, it may take up to 20 to 30 weeks before the cat allergen concentration is reduced to the levels found in animal-free homes. You may be able to speed reduction of the cat allergen by replacing carpet with hard surface flooring, removing any upholstered furniture and drapes used by the former owners, and cleaning the walls. However, all homes, even those never occupied by a cat, will have a minimal level of cat dander that can be measured.
Your allergist should be able to provide medications to help reduce your upper and lower respiratory symptoms for as long as they are needed.
Question
I'm thinking of adopting a soft-coated wheaten terrier for my family. I have many allergies and found out that I am allergic to that kind of dog. Will immunotherapy injections be effective if I do the treatment while living with the dog?
Answer
A dog in the home would not be expected to interfere with immunotherapy injections. However, if you are very sensitive to dog, and you introduce a dog to your home, you may still have significant symptoms, despite immunotherapy. Many patients who start immunotherapy will see a reduction in symptoms within the first six months, while others may need to continue immunotherapy for a few years for symptom relief. Many patients who have both pet allergies, and pet(s) in their home, require a combination of therapies including avoidance, medication and immunotherapy. If you decide to adopt a dog, you should discuss potential strategies with your allergist.
Question
How long after being a dog-free house can I expect allergy symptoms to disappear?
Answer
The specific allergens from dogs are found in almost all homes with a dog, (as well as public buildings and schools) and approximately 15% of homes without a dog. Therefore, even after you find a new home for your pet, you might continue to have exposure to dog allergens, and symptoms related to these exposures.
Strategies to minimize symptoms include reducing or eliminating carpet within the home, using a high-efficiency vacuum with a double or micro-filter bag and using HEPA air cleaners. Although dog allergy symptoms may decrease with avoidance strategies in your home, exposure to dog allergen from sources outside your home may continue to cause bothersome symptoms. In this circumstance, medical treatment and/or allergen immunotherapy may be future options. You should discuss your symptoms and potential strategies for managing symptoms with your allergist.
Question
After a recent trip to the local animal shelter, my children want to adopt a dog or cat. I have a number of allergies and worry that my symptoms will become worse if we bring an animal into our home. I have heard that there are non-allergenic or hypoallergenic dogs, which allow an allergy sufferer to have a pet in their home without having symptoms. Is this true? If so, which types of dog would be considered non-allergenic. Are certain breeds of cats non-allergenic as well?
Answer
Unfortunately there are no “non-allergenic” cat or dog breeds! All of these have some level of allergen. The allergic potential of dogs or cats is not affected by the length of their fur. This is a common myth!
The protein that causes allergies is found in an animal’s saliva, dander and urine. Almost 10 million pet owners – including children – are allergic to their animals.
The fur of a dog or cat can also collect additional allergens, such as pollen and mold spores.
Cats seem to be more allergenic than dogs. Almost all already-allergic people exposed to cats on a regular basis will develop a cat allergy.
If you plan to introduce a pet into your home, have an evaluation by a board-certified allergist, including skin testing. This will tell you for certain what you are allergic to. If you are found to be allergic to dogs or cats, consider immunotherapy (allergy shots). These shots will eventually desensitize you to these animals, so that you may one day be able to have a family pet without compromising your health or well-being.
Question
I have been allergic to animal dander my whole life, but as some cruel twist of fate, I am absolutely crazy about animals. Fortunately, non-sedating antihistamines seem to relieve all of my symptoms. Despite my allergies, I'm considering getting a dog. Is there any harm in using an antihistamine every day? And will it continue to work with constant exposure to an allergen (in this case, dog)?
Answer
The use of long-term antihistamines is not a major concern in terms of drug safety. If you tolerate it now, you should continue to tolerate it. With the older, first generation antihistamines (e.g., diphenhydramine) there can be some loss of effectiveness (sub-sensitivity or tolerance), and while this may also apply to the newer, second generation, non-sedating antihistamines, the evidence is not conclusive.
However, when a patient lives with an animal, their exposure to the allergen is more intense. As a result, they may develop symptoms that are not adequately controlled with any oral antihistamine. In fact, most severely animal-allergic people often require more than one daily medication, and this usually includes a nasal steroid and an eye drop. While use of these medications on a daily basis is quite safe, we do not have data on safety for long-term (e.g., 20+ years) of daily use.
On the other hand, sometimes living with an animal actually slightly increases a patient’s tolerance to the allergen, so that they have are fewer symptoms.
Unfortunately, there is not way to predict which of these scenarios will play out for you, or any other individual to a specific dog. You can be more allergic to one dog than another dog. In addition, a brief exposure to a specific dog may not predict how you will react to that same dog a few weeks later.
Another concern is that by allowing your nose to tolerate the dog (by taking an antihistamine), you are inhaling more dog dander. This increases the possibility of developing allergic asthma, as the lungs have a lining that is very similar to that of the upper airway. While this progression from nasal allergies to asthma is most common in children, it does also occur in adults.
If you are interested in having a dog, consult your allergist and consider starting on a course of allergen immunotherapy (allergy injections) to reduce your sensitivity to dog dander. This is the only form of preventative and long-term control medical treatment available. In addition, a dog-allergen-minimizing home environment would be helpful. Presuming you would have an inside dog, this might include hard surface flooring, leather furniture, a bedroom that is off-limits to the dog, and use of HEPA devices (vacuums and air cleaners).
Question
I thought the flu vaccine changed every year, but my nurse looked at this year’s flu vaccine and found it has H1N1 in it. Isn’t that the same as swine flu?
Answer
Your nurse is right! The terminology is a little confusing, so here’s a refresher: H1N1 is a subtype of Influenza A that has caused roughly half of all human flu infections we’ve seen in the past several years.
H1N1 viruses are identified by two surface proteins: Hemagglutinin (H) and Neuramidase (N). The strains H1, 2 and 3, and N1 and 2 are found in people – a lot more strains are found in birds and pigs, and can be spread to humans. If a sufficient genetic shift occurs in an animal virus strain, it can then be transmitted person to person.
Scientists closely monitor the strains infecting humans as well as animals, since crossover to humans may signal the next pandemic influenza.
Yes, the human influenza strains do shift from year to year, but it is very rare that all three strains in an influenza vaccine change in a single year. Therefore, you will see repeating strains if you watch the vaccines’ contents.
People need a yearly influenza vaccine for two reasons: the vaccines usually contain new strains each year, and immunity to influenza decreases over time. The yearly vaccine helps keep your immunity strong and ensures that you have resistance to the strains scientists have identified as important for the year.
Question
My 4 year-old son recently had anaphylaxis after the following vaccinations were given at the same time: chickenpox, DTP, polio, and MMR. Immediately after these immunizations in our pediatrician's office, he complained of his throat hurting, was sneezing, drooling, threw up and had red, itchy skin and trouble breathing. He was taken by ambulance to the ER, and treated with shots including epinephrine. In the past, he has had drooling and vomiting after eating a piece of protein chocolate bar and when taking his gummy vitamins, and complained of his throat hurting after eating marshmallows. My son doesn't have any hay fever, and we don't have a family history of allergies. Do you have any idea what could be causing these reactions?
Answer
Based on the information you’ve provided, your child’s reactions may be related to gelatin, which is added as a stabilizer to some vaccines and is found in both the MMR (measles-mumps-rubella) and chickenpox (varicella) vaccines. Yellow fever vaccine and rabies vaccine also contain gelatin, but are not part of the routine childhood vaccination schedule.
The foods you list also frequently contain gelatin.
Neomycin, an antibiotic, is another ingredient in some vaccines which can be related to allergic reactions; it can also result in a reaction if used with topical application (as in “triple antibiotic” antibacterial skin creams, sold over-the-counter).
Your allergist can evaluate the possibility of a gelatin (or other) allergy and perform testing on your child to confirm. Given the circumstances, any further vaccinations should be held – and foods containing gelatin avoided – until the exact cause of reactions has been determined.
Question
I am a 66 year-old man who was recently discharged from the hospital after a prolonged and resistant bout of pneumonia. After seeing an allergy/immunology doctor for an evaluation of a possible immune deficiency problem, I had some lab studies done. A certain test called gamma globulin came back in the low normal range, but some of the other tests were not quite normal. The allergist recommended that I have a Pneumovax (pneumococcal vaccine) and a tetanus/diptheria/pertussis vaccination and then have some repeat blood tests. Is it really necessary to have both of these vaccines? How do they help to identify if I have an immune problem?
Answer
Someone with an immune deficiency is very likely to have low normal or even normal gamma globulin levels but still have an inability to make antibodies to specific organisms such as pneumococcus (a bacteria which can cause pneumonia).
The blood work you had taken likely showed your allergist that you lacked proper antibodies to specifically fight pneumococcal diseases and that you lacked protection against tetanus and/or diphtheria. The absence of these antibodies does not in itself mean that you have an immune problem. You may have lost the immunity from the diphtheria/tetanus/pertussis that you had as a child, and may simply not have been exposed to many of the pneumococcal organisms that were tested in the blood.
However, you do need protection against all these organisms – that’s a standard recommendation for all adults over 65! Receiving the vaccines your physician has recommended will likely give you that protection. Repeating the blood tests 4 weeks afer the vaccinations will help your allergist know if your immune system is functioning properly. You really need both vaccinations for protection and to gain necessary information about your immune system. If your body shows an inadequate response to these vaccines, further immune studies and treatment, possibly long-term, may be required.
These vaccines can be administered at the same time. I would suggest that you follow your allergist’s advice and obtain the vaccines and then the blood tests 4 weeks later.
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